Strahlentherapie und Onkologie

, Volume 194, Issue 2, pp 116–124 | Cite as

Neoadjuvant versus definitive chemoradiotherapy for locally advanced esophageal cancer

Outcomes and patterns of failure
  • Matthias Felix Haefner
  • Kristin Lang
  • Vivek Verma
  • Stefan Alexander Koerber
  • Lorenz Uhlmann
  • Juergen Debus
  • Florian Sterzing
Original Article
  • 184 Downloads

Abstract

Purpose

Randomized trials examining neoadjuvant chemoradiotherapy followed by surgical resection (nCRT-S) and definitive CRT (dCRT) for esophageal cancer (EC) patients are hampered by use of nonstandard treatment paradigms. Outcomes of nCRT-S versus dCRT in a more common patient population are lacking. We investigated local control and survival, evaluated clinical factors associated with endpoints, and assessed patterns of failure between these cohorts.

Methods

We retrospectively analyzed 130 patients with locally advanced EC receiving either dCRT or nCRT-S at our institution from 2000–2012. Inclusion criteria were curatively treated nonmetastatic EC, Karnofsky performance status ≥70%, and receipt of concomitant CRT. Patients were excluded if receiving <41 Gy neoadjuvantly or <50 Gy definitively. Kaplan–Meier analysis was used to evaluate local recurrence (LR), progression-free survival (PFS), and overall survival (OS). Univariate and multivariate Cox proportional hazards modeling addressed factors associated with outcomes. Patterns of failure were enumerated as local, regional, or distant.

Results

Mean follow-up was 34.2 months. The 3‑year LR was 10.8% in the nCRT-S group and 21.5% in the dCRT group (p = 0.266). Median PFS were 15.6 and 14.9 months, respectively (p = 0.549). Median OS were 20.6 and 25.9 months, respectively (p = 0.81). On univariate and multivariate analysis, none of the investigated factors was associated with outcomes, although node-positive disease showed a trend for worse OS and PFS. Most common failures in both groups were distant (dCRT 31.2% vs. nCRT-S 21.6%) followed by local in-field recurrences (dCRT 26.9% vs. nCRT-S 10.8%).

Conclusions

In this institutional analysis, no significant differences regarding outcomes and patterns of failure were observed between nCRT-S and dCRT.

Keywords

Neoplasm recurrence, local Esophagectomy Toxicity Survival Treatment failure 

Neoadjuvante vs. definitive Radiochemotherapie bei lokal fortgeschrittenem Ösophaguskarzinom

Outcome und Rezidivmuster

Zusammenfassung

Ziel

Randomisierte Studien, welche die neoadjuvante Radiochemotherapie (CRT) einschließlich konsekutiver Operation (nCRT-S) mit der definitiven Radiochemotherapie (dCRT) für Ösophaguskarzinom(EC)-Patienten vergleichen, sind aufgrund nicht standardgerechter Behandlungskonzepte nur eingeschränkt in die Praxis übertragbar. Zum Vergleich nCRT-S vs. dCRT mit aktueller Standardtherapie liegen kaum Erkenntnisse vor. Verglichen wurden lokale Kontrolle/Überleben, klinische Einflussfaktoren auf das Outcome und Rezidivmuster dieser beiden Gruppen.

Methoden

Wir untersuchten retrospektiv 130 Patienten mit lokal fortgeschrittenem EC, die im Zeitraum 2000–2012 in unserer Klinik mit dCRT oder nCRT-S behandelt worden waren. Einschlusskriterien waren ein kuratives Behandlungskonzept bei nichtmetastasiertem EC, ein Karnofsky-Index ≥70 % und die simultane CRT. Patienten mit einer Gesamtdosis von <41 Gy (neoadjuvant) bzw. <50 Gy (definitiv) wurden ausgeschlossen. Eine Kaplan-Meier-Analyse wurde zur Beurteilung von Lokalrezidiven (LR), progressionsfreiem Überleben (PFS) und Gesamtüberleben (OS) durchgeführt, eine univariate/multivariate Cox-Regression zur Analyse klinischer Einflussfaktoren auf das Outcome. Rezidive wurden als lokal, regional oder distant klassifiziert.

Ergebnisse

Das mittlere Follow-Up betrug 34,2 Monate. Die 3‑Jahres-LR-Raten lagen bei 10,8 % für nCRT-S und 21,5 % für dCRT (p = 0,266). Das mediane PFS betrug 15,6 bzw. 14,9 Monate (p = 0,549), das mediane OS 20,6 bzw. 25,9 Monate (p = 0,81). Univariate und multivariate Analysen zeigten keine klinischen Faktoren mit signifikantem Einfluss auf das Outcome, wenngleich nodal-positive Patienten im Trend ein schlechteres OS und PFS aufwiesen. Rezidive traten in beiden Gruppen meist als Fernmetastasen (dCRT 31,2 % vs. nCRT-S 21,6 %) auf oder als In-field-Lokalrezidive (dCRT 26,9 % vs. nCRT-S 10,8 %).

Schlussfolgerung

Im untersuchten Patientenkollektiv waren im Hinblick auf Outcome und Rezidivmuster keine signifikanten Unterschiede festzustellen nach neoadjuvanter Radiochemotherapie plus Operation bzw. nach definitiver Radiochemotherapie.

Schlüsselwörter

Lokalrezidiv einer Neoplasie Ösophagektomie Toxizität Überleben Therapieversagen 

Notes

Conflict of interest

M.F. Haefner, K. Lang, V. Verma, S.A. Koerber, L. Uhlmann, J. Debus and F. Sterzing declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Deutschland 2017

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity Hospital of HeidelbergHeidelbergGermany
  2. 2.Heidelberg Institute for Radiation Oncology (HIRO)National Center for Radiation Research in Oncology (NCRO)HeidelbergGermany
  3. 3.Department of Radiation OncologyUniversity of Nebraska Medical CenterOmahaUSA
  4. 4.Institute of Medical Biometry and Informatics (IMBI)University of HeidelbergHeidelbergGermany
  5. 5.Department of Radiation OncologyHospital KemptenKemptenGermany

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